Dahan M, Anract P, Babinet A, Larousserie F, Biau D
Orthopedic surgery department, Hospital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Orthopedic surgery department, Hospital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Orthop Traumatol Surg Res. 2017 Nov;103(7):1011-1015. doi: 10.1016/j.otsr.2017.05.019. Epub 2017 Jun 21.
The proximal femuris is an uncommon site of osteosarcoma. The unusual manifestations at this site may lead to diagnostic and therapeutic mistakes. We therefore performed a retrospective study to estimate the proportions of patients with imaging study findings and/or clinical manifestations typical for osteosarcoma and/or inappropriate treatment decisions.
Proximal femoral osteosarcoma often produces atypical clinical and radiological presentations.
Consecutive patients who underwent surgery at our center to treat proximal femoral osteosarcoma were included. For each patient, we collected the epidemiological characteristics, clinical symptoms, imaging study findings, treatment, and tumor outcome. Proportions were computed with their confidence intervals.
Twelve patients had surgery for proximal femoral osteosarcoma between 1986 and 2015. Imaging findings were typical in 1 (8%) patient; they consisted of ill-defined osteolysis in 11/12 (92%) patients, a periosteal reaction in 1/12 (8%) patient, soft tissue involvement in 7/12 (58%) patients, and immature osteoid matrix in 11/12 (92%) patients. No patient had the typical combination of pain with a soft tissue swelling. Management was inappropriate in 2/12 (17%) patients, who did not undergo all the recommended imaging studies before surgery and were treated in another center before the correct diagnosis was established. At last follow-up, 4 patients had died (after a mean of 7 years) and 8 were alive (after a mean of 4 years).
Proximal femoral osteosarcoma is uncommon and rarely produces the typical clinical and imaging study findings. The atypical presentation often results in diagnostic errors and inappropriate treatments. Ill-defined osteolysis on standard radiographs should prompt computed tomography or magnetic resonance imaging of the proximal femur. Treatment in a specialized center is imperative.
IV, retrospective study.
股骨近端是骨肉瘤的罕见发病部位。该部位的异常表现可能导致诊断和治疗失误。因此，我们进行了一项回顾性研究，以评估具有骨肉瘤典型影像学检查结果和/或临床表现的患者比例，以及/或不恰当的治疗决策情况。
股骨近端骨肉瘤常产生非典型的临床和放射学表现。
纳入在我们中心接受手术治疗股骨近端骨肉瘤的连续患者。对于每位患者，我们收集了流行病学特征、临床症状、影像学检查结果、治疗情况及肿瘤转归。计算比例及其置信区间。
1986年至2015年间，12例患者接受了股骨近端骨肉瘤手术。1例（8%）患者的影像学表现典型；12例患者中有11例（92%）表现为边界不清的骨质溶解，1例（8%）患者有骨膜反应，7例（58%）患者有软组织受累，11例（92%）患者有未成熟骨样基质。没有患者出现疼痛伴软组织肿胀的典型表现。2例（17%）患者的治疗不恰当，他们在手术前未进行所有推荐的影像学检查，且在确诊前在另一家中心接受了治疗。在最后一次随访时，4例患者死亡（平均7年后），8例患者存活（平均4年后）。
股骨近端骨肉瘤并不常见，很少出现典型的临床和影像学表现。非典型表现常导致诊断错误和不恰当的治疗。标准X线片上边界不清的骨质溶解应促使对股骨近端进行计算机断层扫描或磁共振成像检查。必须在专业中心进行治疗。
IV级，回顾性研究。
